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. 2022 Jul 27;25(1):6–27. doi: 10.1093/europace/euac062

Table 3.

Potential clinical implications of atrial cardiomyopathy

  • Correlation between MRI-detected fibrosis and AF recurrence, but not ECG phenotype (DECAAF,132 efficacy of late gadolinium enhancement MRI-guided fibrosis ablation vs. conventional catheter ablation of atrial fibrillation)

  • Correlation between atrial fibrosis and difficulty of SR restoration (DECAAF), risk for cerebrovascular events–surrogate (echo contrast) and major adverse cardiovascular events128,129)

Progression, slowing progression

  • Recovery of voltage reduction after successful ablation (CAMERA-MRI, Catheter Ablation Versus Medical Rate Control in Atrial Fibrillation and Systolic Dysfunction133)

  • Recovery of fibrosis—left atrial reverse remodelling after ablation (Echo, MRI)

  • Ventricular fibrosis as marker ablation response (CAMERA-MRI) with regression after restoration of SR134

  • Benefit of early rhythm management of AF (EAST)4

  • Benefit of risk factor management, e.g. weight reduction135 (REVERSE-AF, PREVEntion and regReSsive Effect of weight-loss and risk factor modification on Atrial Fibrillation)

  • Benefit of lifestyle changes, e.g. alcohol abstinence

  • Benefit of upstream therapy (RACE3, targeted therapy of underlying conditions improves sinus rhythm maintenance in patients with persistent atrial fibrillation)136

Potential future clinical implications

  • End-organ damage assessment (e.g. in hypertension)

  • Identification of subgroups of AF patients who benefit from therapies not successful in unselected patients, individualized treatment

  • Tool for patient communication

  • Improved stroke risk assessment, stroke prevention, recurrent stroke prevention (ARCADIA trial)

  • OAC indication in borderline risk patients with AF (BRAIN-AF trial)

  • Prevention of AF onset and progression

  • Inform about the preferential procedural strategy in ablation procedures beyond pulmonary vein isolation

  • Better explain the continuation of OAC after ablation (OCEAN trial137)

ARCADIA, AtRial Cardiopathy and Antithrombotic Drugs In prevention After cryptogenic stroke; CAMERA-MRI, Catheter Ablation Versus Medical Rate Control in Atrial Fibrillation and Systolic Dysfunction; DECAAF, Delayed-Enhancement MRI-Guided Ablation versus Conventional Catheter Ablation of Atrial Fibrillation; EAST, Early treatment of atrial fibrillation for stroke prevention trial; MRI, magnetic resonance imaging; OAC, oral anticoagulant; OCEAN, Optimal anti-Coagulation for Enhanced-risk patients post-catheter Ablation for atrial fibrillation; RACE3, Routine Versus Aggressive Upstream Rhythm Control for Prevention of Early Atrial Fibrillation in Heart Failure.